Knee Deep in Water Chloe
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Post by Knee Deep in Water Chloe on May 8, 2019 22:18:57 GMT -5
Does anyone have dual health insurance coverage?
I'm trying to figure out the differences in how to coordinate benefits.
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Deleted
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Post by Deleted on May 8, 2019 22:26:40 GMT -5
My older son has been double covered the past 15 years. Divorce decree states his Dad's insurance is applied first so it overrides insurance rules, but normally it's whichever insured policyholders birthday is first during the year, so it would be mine. I have to submit something every year to make sure they do it the other way around. Other than that, it's pretty automatic. They bill them in order and then I get anything left.
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tskeeter
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Post by tskeeter on May 8, 2019 22:36:03 GMT -5
Chloe, a caution. I believe that many insurers will no longer coordinate benefits. You probably want to verify that your secondary insurance would actually pay any charges, deductibles, and co-pays not paid by your primary insurance.
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Mardi Gras Audrey
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Post by Mardi Gras Audrey on May 8, 2019 22:47:16 GMT -5
I have double coverage and it has always been pretty easy to deal with. There are industry rules about who is primary, secondary, additional payer (your employer would be primary over a plan where u are dependent, Medicaid is always last, etc).
The providers always dealt with it for me. Usually, they bill the primary and get a payment & explanation of benefits. Then they submit it to the secondary for any amount that needs to be paid by patient (coinsuranse, etc). After the secondary pays what they will, any balance remaining maybe charged to the patient. I’ve never had a remaining balance though (between the two insurers, they pick up 100%).
I currently have a PPO as primary and an HMO as secondary. The HMO said I don’t need to get a referral and see their PCP as long as I meet the rules for the primary insurance. Because the PPO is really flexible (no referrals, big network), the HMO usually just picks up the coinsurance part and I pay nothing. One area where it came in handy was my doc submitted a lab to a lab that was out of network (with primary). Primary paid 60%, secondary got billed and paid about 12%. Because lab was in network with the secondary, they wrote off the rest and didn’t bill me.
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Knee Deep in Water Chloe
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Post by Knee Deep in Water Chloe on May 8, 2019 22:55:05 GMT -5
I appreciate the input. This seems to be a step beyond just the concept of double coverage and what's applied first. That part works out fine. DH is primary as his birthday falls first in the calendar year. I'm secondary. What isn't quite working is whether or not something "counts" once or twice.
So if DD#1 goes to the doctor, somehow a claim is counted toward the deductible on DH's insurance but not on mine. I think.
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Knee Deep in Water Chloe
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Post by Knee Deep in Water Chloe on May 8, 2019 22:55:36 GMT -5
Chloe, a caution. I believe that many insurers will no longer coordinate benefits. You probably want to verify that your secondary insurance would actually pay any charges, deductibles, and co-pays not paid by your primary insurance. This seems to be what's happening. I'm not quite grasping the whole thing though.
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Mardi Gras Audrey
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Post by Mardi Gras Audrey on May 9, 2019 1:29:54 GMT -5
I appreciate the input. This seems to be a step beyond just the concept of double coverage and what's applied first. That part works out fine. DH is primary as his birthday falls first in the calendar year. I'm secondary. What isn't quite working is whether or not something "counts" once or twice.
So if DD#1 goes to the doctor, somehow a claim is counted toward the deductible on DH's insurance but not on mine. I think. That sounds right regarding the deductible. Your DH’s insurance wouldn’t see what the secondary paid so as far as they know, u are the one picking up the tab for the deductible. So from that side it makes sense. Now the issue would be if the secondary (your insurance) doesn’t pay (because u get have a deductible or some other reason), does that count towards ur deductible because u end up paying. I would think it should if you actually paid but that would be dependent on what the plan docs said. I know in my experience, the primary gave me credit for what the secondary paid as if I paid it personally. When I had double PPO coverage with blue cross, I ended up hitting the out of pocket max of like $6k? With the primary but only had paid like $400 out of pocket because the secondary picked all the rest up (the $400 were bills I had before I had the second insurance coverage). It was Pretty nice because the primary then paid everything at 100% even though I only paid the $400
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Mardi Gras Audrey
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Post by Mardi Gras Audrey on May 9, 2019 1:38:21 GMT -5
Now that I think about it, I don’t think the secondary even made me meet the deductible. They just seem to pay whatever the primary didn’t pay. It may have been because it was tricare (military insurance) and they have weird rules. I remember the plan info saying there was supposed to be some small deductible but who knows? They just seem to pay everything and would never send me an EOB so I just moved on
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Post by The Walk of the Penguin Mich on May 9, 2019 11:44:53 GMT -5
LOL! It is a mess!
I am laughing at this because I am doubled insured by Medicare and Blue Cross (a normal health insurance policy, NOT Medigap). I am dealing with this with regards to my PT benefits right now.....either I owe my PT a lot of money or nothing, as she does not accept Medicare. In my case, primary insurance depends upon whether or not there are 100 employees of the employer’s policy.
Clear as mud.
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TheHaitian
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Post by TheHaitian on May 9, 2019 14:05:16 GMT -5
I appreciate the input. This seems to be a step beyond just the concept of double coverage and what's applied first. That part works out fine. DH is primary as his birthday falls first in the calendar year. I'm secondary. What isn't quite working is whether or not something "counts" once or twice.
So if DD#1 goes to the doctor, somehow a claim is counted toward the deductible on DH's insurance but not on mine. I think. That sounds about right unless your DH insurance does not cover the total cost, they can put a claim on your insurance for remainder of the cost. Ex. I am on a expensive drug that cost ~$1,700/month My primary insurance (because I get it from my job) does not kick in till I hit $3,500 in deductible. The second insurance kicks in after primary. So for the first 2 refills of the year (Jan/Feb) the pharmacy will put a claim with my primary first, they will not cover it because I did not meet deductible yet... and then Pharmacy will put a claim with my secondary insurance that will cover it. Now by March primary insurance does not know I have a secondary insurance, and think I have met deductible it will cover the refill at 80%, leaving a tab of $200 for me to pick up. They will process the remainder of the $200 through my secondary insurance that will cover it. The moment I hit full OOP max on my primary or it is for regular check up that they cover 100%, no claims is put trough my secondary insurance. The only claim my secondary insurance receives is claims that primary insurance did not pay (did not reach deductible) or there is a balance remaining after primary insurance paid their part.
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Knee Deep in Water Chloe
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Post by Knee Deep in Water Chloe on May 14, 2019 20:27:37 GMT -5
Sigh. Part of the problem is that DD accidentally picked a provider who is out-of-network. She thought she'd picked one who was in network, but that is not so much what happened. The other problem is that I may have set her up on a plan that does not cover out of state treatment (except for emergency services). We live in one state; she is at college in another state.
This appointment is definitely going to cost me another $1,100. It's already cost me $440 for the initial appointment, but that's because I thought we'd not met the deductible at that point. It was actually because it was out-of-network.
It's not bail money, right? Health care is a good thing, right?
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wvugurl26
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Post by wvugurl26 on May 14, 2019 20:55:39 GMT -5
Sigh. Part of the problem is that DD accidentally picked a provider who is out-of-network. She thought she'd picked one who was in network, but that is not so much what happened. The other problem is that I may have set her up on a plan that does not cover out of state treatment (except for emergency services). We live in one state; she is at college in another state.
This appointment is definitely going to cost me another $1,100. It's already cost me $440 for the initial appointment, but that's because I thought we'd not met the deductible at that point. It was actually because it was out-of-network.
It's not bail money, right? Health care is a good thing, right? I had a plan like that and it had an exception for college students. You might check into it after your surgery.
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Knee Deep in Water Chloe
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Post by Knee Deep in Water Chloe on May 22, 2019 17:24:09 GMT -5
Update in case you're bored and want something to read:
Because health care billing in America is lovely.
The health insurance representative believes I selected a plan that only allows visits to certain doctors in a geographical area. While I don't doubt that I may have done that in order to attempt saving some money, I'm still trying to figure out if that's what I actually did.
There seems to be a weird rule that says I should be the girls' primary insurer and DH the secondary insurer even though our birthdays are in reverse order. It probably has to do with DH being their step-father and not their biological father. However, the insurance customer service rep doesn't seem to want to figure any of it out.
And last, there are three claims with this provider now for DD#1. Initial visit; procedure visit; follow-up visit.
On my EOB and DH's EOB Visit #1 does not indicate whether or not the provider is in-network or out-of-network. Nothing was covered insurance; however, we'd not yet met the deductible for the insurance year.
On my EOB and DH's EOB Visit #2 indicates that the provider is out-of-network; there was a contractual reduction in the bill. The remainder of the bill was not covered by insurance.
On my EOB: (haven't received DH's EOB yet) Visit #3 indicates that the the provider is in-network, and insurance fully covered the bill. We had met the deductible (yay blood clot!) by that point.
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TheOtherMe
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Post by TheOtherMe on May 22, 2019 18:00:50 GMT -5
How did the provider become in-network for Visit #3?
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CCL
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Post by CCL on May 23, 2019 10:19:32 GMT -5
Can you go thru the insurance plan website to verify whether or not the provider is in-network?
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Knee Deep in Water Chloe
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Post by Knee Deep in Water Chloe on May 25, 2019 14:40:55 GMT -5
How did the provider become in-network for Visit #3? An excellent question that I cannot answer.
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Knee Deep in Water Chloe
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Post by Knee Deep in Water Chloe on May 25, 2019 14:46:25 GMT -5
Can you go thru the insurance plan website to verify whether or not the provider is in-network? I’ve done that myself and on the phone with an insurance customer service representative. From my view, it’s definitely not a provider. The CSR thinks it’s due to DD’s address being listed as my address and the provider being over 200 miles away. There is the potential of DD, when she went through the insurance website to find a provider, she saw Freckles Inc on there And then when she called them, they told her to call Freckles Center. That’s where she didn’t realize they were completely separate entities. Freckles Inc is a medical supply store not a doctor’s office.
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